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HomeMy WebLinkAbout04-0135PETITION FOR PROBATE and GRANT OF LETTERS Estate of' ,,~ T'7-/ Lz ,~, ~[~ 7~ ?/:7~1J No. also known as To: Social Security No. ~73o? - O~ - ~7 0Deceased' ~t - oct - t3.5 Register of Wills for the County of ~a~/~¢r'/a ~ Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older an the executVtx in the last will of the above decedent, dated /o / z-z~ and codicil(s) dated in the named ,.19 (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in ~o.~ ~ ~r-Ia ~ d~. Co~unty, Pen.nsylvania, with last family or principal residence at (list street, number and muncipality) D~endent: then ? / years of age, died // //o7 P , -1~ , Except as ~ollows, decedent did not marry, was not divorced and difi not have a child born or adopted" ' after execution of the will offered for probate; was not the victim of a killing and was never adjudicated incompetent: Decendent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property $ (If not domiciled in Pa.) Personal property in Pennsylvania $ (If not domiciled in Pa.) Personal property in County $ Value of real estate in Pen~ylvania $ situated as follows: )'/o~a_.- WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) presented herewith and the grant of letters theron. '(testamentary;- administration c.t.a.; administration d.b.n.c.t.a.) OATH OF' PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA ] COUNTY OF (~~a~u~ f ss The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen- tative(s) of the above decedent petitioner(s) will well ~nd trUly administer the estate according to law. S orn to or affirmed and subscribed .- before .n~.his .\ ~A-~, . day of [ . , , _ x--~-.~ ~ a~ _ ~._~q '1'9 J ' ~ ~,~ O Register [ No. ~ - Ocl o ~35 Estate Of HETTIE F .MATTFRN , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW FEBRUARY 11: 2004 19 , in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated 10-22-1996 described therein be admitted to probate and filed of record as the last will of HETTIE F MATTERN ; and Letters T[qT/~MENT/~P.Y are hereby granted to VIRGINIA ROSE MATTERN £OVAI F%t(T FEES Probate, Letters, Etc .......... $ Short Certificates( ) .......... $ q.oo TOTAL $ "]~. OD. Filed ......... 2 + 3.1.-.200.4 ................ waited for the shorts received the ATTORNEY (Sup. Ct. I.D. No.) ADDRESS same day PHONE .. -'!.u~f,0 Z£: i[~' t t ~]3J lz0. : _ -: AFFADAVIT OF SUBSCRIBING WITNESS COMMONWEALTH OF PENNSYLVANIA, ) ) COUNTY OF CUMBERLAND S.S.: BE IT KNOWN, that on this ~ day of February, 2004, before me, a Notary Public in and for said Commonwealth and County, personally appeared, Betty K. Kleinle, one of the subscribing witnesses to the foregoing instrument of writing, purporting to be the Last Will and Testament/Codicil ofHettie F. Mattern, Deceased, and on her solemn oath did depose and say that she was therein named, sign, seal, publish, and declare the same as and for her Last Will and Testament/Codicil, and at the time of so doing, she was of sound mind and memory, to the best of her knowledge and belief, and at her request and in her presence she subscribed her name as witness. r-/r Betty ~.~it[lein[e~5 Notarial Seal Kim W. Mills. Notary Public Carlisle Boro, Cumberland County My ~ssion Expires Mar. 27, 2007 Member, Pennsylvania Association Of Notaries AFFADAVIT OF SUBSCRIBING WITNESS COMMONWEALTH OF PENNSYLVANIA, ) ) COUNTY OF CUMBERLAND S.S.: BE IT KNOWN, that on this 4- day of February, 2004, before me, a Notary Public in and for said Commonwealth and County, personally appeared, Vicky Lynn Bogus, one of the subscribing witnesses to the foregoing instrument of writing, purporting to be the Last Will and Testament/Codicil ofHettie F. Mattern, Deceased, and on her solemn oath did depose and say that she was therein named, sign, seal, publish, and declare the same as and for her Last Will and Testament/Codicil, and at the time of so doing, she was of sound mind and memory, to the best of her knowledge and belief, and at her request and in her presence she subscribed her name as witness. J Notadal Seal [ Kim W. Mills, Notaq/Public Carlisle Boro, Cumberland County My Commission Expires Mar. 27, 2007 Member, Pennsylvania Association Of Notaries his is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. ;~ . , Fee for this certificate, $2.00 Loe/a4/Regis trar / P 9 8 5 2 9 7 4 No. ~ Date ,. Hettie F. Mattetm ,. 91 Cumberland 24 Nat~ ~ossing ,t ~la, PA 17025 ~ S~el COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH 7.'~'~ 7~ ..... W 3070 7'~'~' I' l' -- -- I.November 2% 2003 mfept.27,'z2 m~rtle. Creek,PAJ.~a.~ ,~= __~m ,l~a S~lver Spri~ ~J 24 Nat~es Crossino ~ ~Q"--~ Silver Spring Cumberland LAST WILL AND TESTAMENT OF HETTIE F. MATTERN I, HETTIE F. MATTERN, of the Township of Silver Springs, Cumberland County, Commonwealth of Pennsylvania, being of sound mind, memory and understanding, do make and publish this my Last Will and Testament, hereby revoking and making void all former Wills by me at any time heretofore made. ITEM I. I direct that all my just debts, funeral expenses and inheritance taxes which may become due as a result of my death be fully paid and satisfied as soon as conveniently may be after my decease. ITEM II. I give, devise and bequeath all of the rest, residue and remainder of my estate of every nature and wherever situate to my daughter, VIRGINIA ROSE MATTERN COVALESKI, provided she shall survive me by thirty (30) days. ITEM III. In the event that my daughter, VIRGINIA ROSE MATTERN COVALESKI, shall predecease me, or die on or before the thirthieth day following my death, then I give, devise and bequeath all of my estate of every nature and wherever situate, in four equal shares as follows: two shares to my son- in-law, DONALD R. COVALESKI, one share to my granddaughter, DEBRA ROSE COVALESKI MILLER and one share to my grandson, DONALD VINCENT COVALESKI. In the event both VIRGINIA and DONALD R. predecease me, I give their shares to their living, natural-born issue. In the event either DEBRA or DONALD VINCENT predecease me, I give their share to their living, natural-born issue. ITEM IV. In the event all of the beneficiaries identified in the preceding Item predecease me, and leave no issue surviving, I then give, devise and bequeath all of my estate of every nature and wherever situate, as follows: (a) $10,000 I give, devise and bequeath to Carnegie Mellon University; Pittsburgh, Pennsylvania, to be used for students scholarships. (b) $10,000 I give, devise and bequeath to Hailman- Monroeville Lodge No. 786; Plum Boro Masonic Hall, 9521 Saltsburg Road, Pittsburgh, Pennsylvania 15239, to be used in a childrens hospital. (c) The entire remaining balance I give, devise and bequeath to the Capital Area Christian Church, Enola, Pennsylvania. ITEM V. I appoint my daughter, VIRGINIA ROSE MATTERN COVALESKI, to be and act as Executrix of this, my Last Will and Testament. In the event my daughter, VIRGINIA ROSE MATTERN COVALESKI, predeceases me or otherwise fails to qualify as Executrix, I appoint my son-in-law, DONALD R. COVALESKI, to be and act as Executor of this, my Last Will and Testament. No bond shall be required by my Executrix/Executor in Pennsylvania or any other jurisdiction. IN WITNESS WHEREOF, Ihave hereunto set my hand and seal this D~ day of 0C~. , 1996. HETTIE F. MATTERN The preceding instrument, consisting of this and two other typewritten pages, was on the date thereof signed, published and declared by HETTIE F. MATTERN, the Testator therein named, as and for her Last Will, in the presence of us, who at her request in her presence and in the presence of each other, have subscribed our names as witnesses hereto. Residing at Residing at LAST WILL AND TESTAMENT OF HETTIE F. MATTERN Name of Decedent: CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Date of Death: Will No. Admin. No. To the Register: I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of.the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate onL.)~ ~ ~ / ! ; _.oo63 : Name Address Notice has now been given to all persons entitled thereto under Rule 5.6(a) except. Date: Capacity: Signature ¢.z~~'~. ~ Address Telephone (~//~ ~ ~/~ Ox.-Oo Personal Representative Counsel for personal representative IMPORTANT NOTICE NOTICE OF ESTATE ADMINISTRATION THIS NOTICE DOES NOT MEAN THAT YOU WILL RECEIVE ANY MONEY OR PROPERTY FROM THIS ESTATE OR OTHERWISE. Whether you will receive any money or property will be deter- mined wholly or partly by the decedent's will. If the decedent died without a will, whether you will receive any money or prop- erty will be determined by the intestacy laws of Pennsylvania. BEFORE THE REGISTER OF WILLS, COUNTY OF CUMBERLAND, CARLISLE, PA In re Estate of /J/~ 7'"7'/~ ~ /n4/q '7-7'~_~flJ , deceased, Estate No. (Name and Address) Please take notice of the death of decedent and the grant of letters to the personal representative(s) named below. The Decedent /~W ~/~ ~ ~ ~M , died on the ~ Y ~ day of ~0~ ~ , ~o~ , at ~a~ ~er [~n~ County, Pennsylvania. e Decedent died testate (with a Wil~r The Decedent died intestate (without a Will). The personal representative of the Decedent is (n~e, ad,ess and telephone number). If the Decedent died testate, the will has been filed with the Office of the Register of Wills of Cumberland County, 1 Courthouse Square, Carlisle, Pa. 17013. Phone No. 717-240-6345 If the Decedent died intestate, a Petition for the Grant of Letters of Administration was filed with the Office of the Register of Wills of Cumberland County, 1 Courthouse Square, Carlisle, Pa. 17013. Phone No. 717-240-6345 A copy of the Will or Petition may be obtained by contacting the Register of Wills and paying the charges for duplication. Date: OR//r /:~o o ~ Signature: '~),t~ Name (print) Telephone ('7/7) ~o ~/ - ~0 o Capacity:~ C oun se 1 orT6'f-p-er sonal representative Name of Decedent: STATUS REPORT UNDER RULE 6.12 Date: Date of Death: //f o~ ? /R o o 3 Will No.: Admin. No.: Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes ["] No [] 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: -~"~ e.. ~ ~ 0o~ q/ 3. If the answer t° No. 1 is Yes, state the following: a.Did the personal representative file a final account with the Court? Yes _ No ['] b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account in.formally to the parties in interest? Yes [-'] No [~ c. Copies of receipts, releases, joinders and approval of formal or informal accounts may be filed with the Clerk of the. Orphans' Court and may be attached to this report. Signa'~ e~ Capacity: Name Ad,ess ~ Telephone No. ~erson~ Representative Co~sel for personal representative co..o.,,,,,o, REV- 1 500 PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 INHERITANCE TAX RETURN 4~~ HARRISBURG, PA 17128-0601 RESIBENT BECEBENT I,.= Z LI.I 0 0 DECEDENTS NAME (LAST. FIRST. AN~ MIDDLE INITIAL) DATE OF DEATH (MM-DD-YEAR) [ DATE OF BIRTH (MM-DD-YEAR) (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, ANB MIDBLE INITIAL) USE £)NLY FILE NUMBER cou~cc~ ~-'~',~ SOCIAL SECURITY NUMBER THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER E~ Original Return ~, 2. Supplemental Return [~4. Limited Estate [~ 4a. Future Interest Compromise (dat~ of death ,~r [~6. Decedent Died Testate iA~ch cop~' of wi~i~ F--] 7. Decedent Maintained a Living Trust (^tt~c~ copy o~ ~-'~ 9. Litigation Proceeds Received [~ 10, Spousal Poverty Credit (date of death be~aen 12-31-9~ - .......... ~-- ',""~ COMPLETE MAILING ADDRESS NAME VI~ ~'/~/~ O J~'~¢.&~"~',/¢/ ~ 4' [--'~ 3~ Remainder Return {date of death peer I~ 12-13~82~ [~5, Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes [--~ 11. Election [o tax under Sec, 9113(A) I~c~ FIRM NAME TELEPHONE NUMBER · -~/F -~ ¢/~ ~,c, / 1. Real Estate (Schedule A) (1) 2, Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or sele-Proprietorship (3) 4. Modgages & Notes Receivable (Schedule D) (4) 5. Cash. Bank Deposits & Miscellaneous Pem,.onai Property (5) (Schedule E) 6. Jointly Owned Property (Schedule F) (6) ~ separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Nor~.Probate Property (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9, Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule l) (10) 11. Total Deductions (lotal Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) (6) 21 .~'o (11) (12) .......... ~SFFI'~'iALUSE"~-~,]'"~O 13. Charitable and Governmental Bequosts/Sec 9113 Trusts for which an elec~n to tax has not been made (Schedule J) 14, Net Value Subject to Tax (Line 12 minus Line 13) (13) (14) q/,~Z~. 2.0 I SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15, Amount of Line 14 taxable at ~he spousal tax rate, or transfers under Sec, 9116 (a)(1.2) 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate "" x .o_ (15) ¢'/~ ~ Z~, ~.o x .045' (16) "" x .12 (17) x .15 (18) (19) 19, Tax Due Decedent's Complete Address: STREET ADDRESS CITY ISTATE Tax Payments and Credits: 1, Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B Pdor Payments C. Discount Interest/Penalty if applicable D. Interest E. Penalty If Line 2 is greater than Line 1 + Line 3, enter the difference, This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX BUE. A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (1) Total Credits ( A + B + C ) (2) (3) (4) (5) (5A) (5B) Total Interest/Penalty ( D + E ) Make Check Payable to: REGISTER OF WILLS, AGENT ,'~$.~ I PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS No Did decedent make a transfer and: Yes a. retain the use or income of the property transferred; .......................................................................................... [] b. retain the fight to designate who shall use the property transferred or its income; ............................................ [] c. retain a reversionary interest; or .......................................................................................................................... [] d. receive the promise for life of either payments, benefits or care? ...................................................................... [] 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. [] 3. Did decedent own an "in trust for" or payable upon death bank account or secudty at his or her death? .............. [] 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ [] IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my know~edge and belief, it is true, correct and complete Declaration of preparer other than the personal representative is based on all information of which preparer has any know~edge. SIGNATURE OF PER~ON RESPONSIBLE FOR FILING RETURN ADDRESS SIGNATURE OF P~,PA~N_R~~IVE ADDRESS DATE DATE . /o q-- ~..--- For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. §9116 (a) (1.1) (ii) The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive paren' or a stepparent of the child is 0% [72 P.S. §9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal benefidaries is 4.5%, except as noted in 72 P.S. {}9116(1.2) [72 P,S. §9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. {}9116(a)(1.3)]. A sibling is defined, under Section 9102, as a~ individual who has at least one parent in common with the decedent, whether by blood or adoption. COMMONWEALTH OF PENNSYLVANIA 1NHERITANGE TAX RETURN RESIDENT DEC_.,,EOE NT E~I'ATE OF SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY :ILE Include m proceeds of litigation and lhe da~e the _procee~___~ were received by t~e esta~. All property joinlJy-ow~l wi~ b~e right of su~ivorship must be disclosed on Schedule F, ITEM NUMBER I0 /I DESCRIPTION ~ z./o 4./0 ~ ~ 5'/-40:Z4-/,z¢8 VALUE AT DATE OF DEATH TOTAL (Also enter on line 5, Recapitulation) s /Z /3 /4 (If mom space is needed, insert additional sheets of the same size) SCHEDULE F JOINTLY-OWNED PROPERTY FILE if ~ ~.e~ w~ made joint w~hin one yeer of the deeedent't d~l~ of de~tl~, i~ mu~t be repmt"d on Schedule G. SURVIVING JOINT TENANT[S) NAME ADORESS RELATiONSHiP TO DECEOENT /--,z $ ~? JOINTLY-OWNED PROPERTY: LETTER DATE ~¥K~'N O~ ~t~,~F_RTY % OF DATE OF DEATH iTEM FOR JOl~T 1~4)E include narre of f~mcia ~.~tiluli~ and bank ~ n~mb~ o~ simtla' ide~if/ing number- Altac~ DATE OF DEATH DECD'S VALUE OF ~a__~_ _R TEN~ JOINT daed f~' join~l,/-~ real ~ VALUE OF ASSET ~NTEREST DECED~NT'S INTEREST v8 t~Tz8 cu~tp ~z~z4 ~o 8 (If mom space ts needed, inse~ ~ sheets oflhe same size) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE G INTER-VIVOS TRANSFERS 8, MISC. NON-PROBATE PROPERTY 'FILE NUMBER This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes, DESCRIPTION OF PROPERTY % OF ITEM INCLuGETHENAME OE Ti'~ TI~REF., THE{RRE!.AT1ONSHIPTO OECEDENTANO THE ~TE O~ "W~SF~ DA~ OF DEA~ DECD'S EXCLUSI~ TA~BLE VALUE NU~ER VALUE ~ A~ IN. REST TOT~(Alsoent~oniine7, R~tuta,on) $ (If more space is needed, insert additional sheets of the same size) REV-1511 EX+ (12-99)~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Debts of decedent must be reported on Schedule L ITEM NUMBER DESCRIPTION AMOUNT FUNERAL EXPENSES: ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s)/EIN Number of Personal Re Street Address ,,~,~ /~I~,"~ U~' $..~'/~-- c~ Year(s) Commission Paid: State Attorney Fees Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) C~a~mant ~'/,,,,¢_. ,~/,,¢,,'~ Streat Address 2'~· Relationship of Claimant to Decedent State¢'~/~ Zip Probate Fees Accountant's Fees Tax Return Preparer's Fees TOTAL (Also enter on line 9, Recapitulation) (If more space is needed, insert additional sheets of the same size) COMMONWEALTH OF PENNSYLVANV~, INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES~ & LIENS ESTATE OF FILE NUMBER Include unr~ ITEM NUMBER ~imbursed medical expenses. DESCRIPTION TOTAL (Also enter on line 10, Recapitulation) $ AMOUNT (If more space is needed, insert additional sheets of the same size) COI~I~MONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD REV-1162 EX(11-96) OO3549 COVALESKI VIRGINIA ROSE MATTERN 24 NATURES CROSSING ENOLA, PA 17025-1047 ACN ASSESSMENT CONTROL NUMBER AMOUNT ........ fold 101 $3,925.57 ' ~ON: SSN: 232-03-3070  2104-0135  MATTERN HETTIE F  NT: 02/11 /2004 ~.~R K DAT.E: 00/00/0000 ~.~TY: ~. CUMBERLAND 1DATE'~F ~; 11/29/2003 REMARKS: CHECK# 2852 SEAL TOTAL AMOUNT PAID: $3,925.57 INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. Z80601 HARRISBURG, PA 17128-0601 VIRGINIA H COVALESKI Zq NATURES XZNG ENOLA CONNONgEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAZSEHENT. ALLOHANCE OR DZSALLO#ANCE OF DEDUCTIONS, AND ASSESSHENT OF TAX ON JOINTLY HELD OR TRUST ASSETS ©SATE 05-15-2004 ' ~ ESTATE OF MATTERN DATE OF DEATH 11-Zg-ZO05 FILE NUHBER .~UNTY *~N/DC ACN ~,t'~ ,~ [' _ 21 04-0135 CUHBERLAND 232-03-3070 04104642 Amoun~ Rem~.'~'~ed REV-15~I8 EX AFP (Ol-g3) HETTIE HAKE CHECK PAYABLE AND REHZT PAYHENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE I~ RETAIN LONER PORTION FOR YOUR RECORDS ~ REV-15&8 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAZSEHENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 05-15-2004 ESTATE OF MATTERN HETTIE F DATE OF DEATH 11-Z9-2003 COUNTY CUHBERLAND FILE NO. 21 04-0135 S.S/D.C. NO. Z3Z-03-3070 ACN 04104642 TAX RETURN WAS: eX) ACCEPTED AS FILED ¢ ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: PNC BANK ACCOUNT NO. 5140241298 TYPE OF ACCOUNT: ( ) SAVINGS (~ CHECKING ( ) TRUST ( ) TIHE CERTIFICATE DATE ESTABLISHED 06-29-1984 Account Balance Percent Taxable X 0.500 Amount Subject to Tax 1Z,94Z.69 Debts and Deductions - .00 Taxable Amount 1Z,94Z.69 Tax Rate Tax Due 582.42 TAX CREDITS: 25,885.$8 NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBHIT THE UPPER PORTION OF THIS NOTICE WITH YOUR TAX PAYMENT TO THE REGISTER OF WILLS AT THE ABOVE ADDRESS. HAKE CHECK OR HONEY ORDER PAYABLE TO: "REGISTER OF WILLS, AGENT." PAYMENT RECEIPT DISCOUNT (+) DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID PAYHENT HUST BE MADE BY 08-30-Z004~. TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE ZF PAID AFTER THTS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. x ( ZF TOTAL DUE ZS LESS THAN $1, NO PAYHENT ZS REQUIRED. ZF TOTAL DUE ZS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. ) .00 582.42 .00 582.42 PURPOSE OF NOTICE: To fulfill the requirements of Section 1140 of the Inheritance and Estate Tax Act, Act 13 of ZOO0. Section 9140). PAYMENT: Detach the top portion of this Notice and submit with your payment to the Register of Nills printed on the reverse side. -- Hake check or money order payable to: REGISTER OF HILLS, AGENT. REFUND (CR): OBJECTIONS: ADNIN- /STRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: A refund of a tax credit, which ams not requested on the tax return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications ara available at the Office of the Register of Wills, any of tho 23 Revenue District Offices or by calling the special Z4-hour answering service for forms ordering: 1-800-362-2050; services for taxpayers aith special hearing and or speaking needs: 1-800-447-3010 (TT only). Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions or assessment of tax (including discount or interest) as shown on this Notice may object within sixty (60) days of receipt of this Notice by: --written protest to tho PA Department of Revenue, Board of Appeals, Dept. 181011, Harrisburg, PA 171ZB-lOZZ, OR --electing to have the matter determined at the audit of the account of the personal representative, OR --appeal to the Orphans' Court Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, DEPT. 180601, Harrisburg~ PA 17118-0601 Phone (717) 787-6505. Sea page S of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-IS01) for an explanation of administratively correctable errors. If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (51) discount of the tax paid is allowed. The 151 tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in tho same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 1981 bear interest at the rate of six (61) percent per annum calculated at a daily rate of .000164. A11 taxes ahich became delinquent on or after January 1, 1981 will bear interest at a rate which will vary from calendar year to calendar year with that rate announced by tho PA Department of Revenue. The applicable interest rates for 1981 through Z004 are: Interest Daily Interest Daily Interest Dally Year Rate Factor Year Rate Factor Year Rate Factor 198Z ZOZ .000548 198--8-1991 111 .00030! ZO0~ 9Z .000Z47 1983 161 .000438 199Z 91 .000Z47 ZOOZ 61 .000119 1984 llX .000301 1993-1994 72 .000191 2003 52 .000137 1985 132 .000356 1995-1998 9X .000247 Z004 41 .000110 1986 101 .000274 1999 72 .000192 1987 9Z .000Z47 ZOO0 81 .000Z19 --Interest is calculated as follows: TNTEREST = BALANCE OF TAX UNPAZD X NUI~BBR OF DAYS DEL/NQUENT X DA/LY TNTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest eust be calculated. BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. Z80601 HARRISBURG., PA 17128-0601 VIRGINIA 24 NATURES XING ENOLA COMMON#EALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX &PPRA/SENENT, ALLONANCE OR DISALLO#ANCE OF DEDUCTIONS, AND ASSESSHENT OF T&X ON JOINTLY HELD OR TRUST ASSETS M COVALESKI 'DJ, H/~R 12 P l:J4 PA ~7025, REV-1S~i8 EX AFP (01-05) DATE 05-15-2004 ESTATE OF MATTERN HETTIE DATE OF DEATH 11-29-2005 FILE NUMBER 21 04-0155 COUNTY CUMBERLAND SSN/DC 232-05-$070 ACN 04104640 Amoun~ RemL~ed MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF HILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LXNE ~ RETAIN LONER PORT'rON FOR YOUR RECORDS REV-15&8 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLONANCE OR DZSALLONANCE OF DEDUCTIONS, AND ASSESSHENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE ESTATE OF MATTERN HETTIE F DATE OF DEATH 11-Zg-ZO05 COUNTY CUHBERLAND FILE NO. 21 04-0155 S.S/D.C. NO. ZSZ-O$-$070 ACN TAX RETURN NAS: eX) ACCEPTED AS FILED ( ) CHANGED 04104640 JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: PHC BANK ACCOUNT NO. $1400215757 TYPE OF ACCOUNT: ( ) SAVINGS ( ) CHECKING ( ) TRUST (~ TIHE CERTIFICATE DATE ESTABLISHED 07-14-2001 Account Balance Percent TaxabZe X 0.500 Amount Subject to Tax 5,010.52 Debts and DeductAons - .00 Taxable Amount 5,010.52 Tax Rate X .45 Tax Due 225.47 TAX CREDITS: 10,021.04 NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS NOTICE NITH YOUR TAX PAYMENT TO THE REGISTER OF HILLS AT THE ABOVE ADDRESS. MAKE CHECK OR MONEY ORDER PAYABLE TO: "REGISTER OF HILLS, AGENT." PAYHENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) PAYMENT MUST BE HADE BY 08-$0-2004~. TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE ZF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ~ ( ZF TOTAL DUE ZS LESS THAN $1, NO PAYHENT ZS RE{~UZRED. IF TOTAL DUE ZS REFLECTED AS A 'CREDIT' (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. ) .00 225.47 .00 225.47 PURPOSE OF NOTICE: To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 13 of ZOO0. (71 P.S. Section 9140). PAYNENT: Detach the top portion of this Notice and submit mith your payment to the Register of Nills printed on the reverse side. -- Hake check or money order payable to: REGISTER OF NILLS, AGENT. REFUND (CR): OBJECTIONS: ADNIN- ZSTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: A refund of a tax credit, ehich ems not requested on the tax return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1315). Applications are available et the Office of the Register of #ills, any of the Z$ Revenue District Offices or by calling the special Z4-hour ansaering service for forms ordering: 1-800-S6Z-ZO50; services for taxpayers with special hearing and or speaking needs: 1-800-447-30Z0 (TT only). Any party in interest not satisfied aith the appraisement, allowance, or disallowance of deductions or assessment of tax (including discount or interest) as shown on this Notice amy object within sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. ZBiOZi, Harrisburg, PA 17128-10Z1, OR --electing to have the matter determined at the audit of the account of the personal representative, OR --appeal to the Orphans' Court Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, DEPT. 280601, Harrisburg, PA 17128-0601 Phone (717) 787-6505. Sam page S of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. If any tax due is paid within three (3) calendar months after the decsdent's death, a five percent (51) discount of the tax paid is allowed. The 1SI tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same tiao period as you would appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 1981 bear interest at the rate of six (61) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on or after January l, 1981 will bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 1981 through Z004 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 198~ ZOZ .000S48 198-'--8-1991 111 .000301 2009 91 .000247 1983 161 .000438 I99Z 91 ,000147 ZOOZ 61 .000119 1984 llZ .000301 1993-1994 71 .000192 2003 51 .000137 1985 132 .000356 1995-1998 92 .000247 2006 42 .000110 1986 lOX .000174 1999 7Z .00019Z 1987 92 .000267 ZOO0 82 .000219 --Interest is calculated as follows: XNTEREST= BALANCE OF TAX UNPAXD X NUIIBBR OF DAYS DBLTNQUENT X DAZEY ZNTERBST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the data of the assessment. If payment is made after the interest computation date shown on tho Notice, additionaZ interest must be calcuIated. BUREAU OF INDIVIDUAL TAXES INHERTTAHCE TAX DEPT. Z80601 HARRTSBURG, PA 17128-0601 COHHONWEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEHENT. ALLONANCE OR DISALLONANCE OF DEDUCTIONS, AND ASSESSHENT OF TAX ON JOINTLY HELD OR TRUST ASSETS C0VA~_~KiPI~R____ 12 P1:44 VIRGINIA 2q NATURES XING ENOLA (~iCA:- 17025 ~ DATE 03-15-200q ESTATE OF HATTERN DATE OF DEATH 11-29-2005 FILE NUHBER 21 0q-0155 COUNTY CUHBERLAND SSN/DC 252-05-$070 ACN 0~10~6~1 I Amoun'~ Remi*t'ted RE¥-I;~8 EX AFP [01-03) HETTIE F HAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS *~ REV-1548 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSHENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 05-15-200~ ESTATE OF MATTERN HETTIE F DATE OF DEATH 11-29-2003 COUNTY CUHBERLAND FILE NO. 21 0q-0135 S.S/D.C. NO. 232-03-3070 ACN OqlOq6ql TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED JOINT OR TRUST ASSET ZNFORHATION FINANCIAL INSTITUTION: PNC BANK ACCOUNT NO. 3100003~378 TYPE OF ACCOUNT: ( ) SAVINGS ( ) CHECKING ( ) TRUST (~ TIHE CERTIFICATE DATE ESTABLISHED 0q-16-1996 Account Balance Percent Taxable X 0.500 Amount SubSect to Tax 5,005.68 Debts and Deductions - .00 Taxable Amount 5,005.68 Tax Rate X .~5 Tax Due ZZS.Z6 TAX CREDITS: 10,011.36 NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS NOTICE WITH YOUR TAX PAYMENT TO THE REGISTER OF WILLS AT THE ABOVE ADDRESS. MAKE CHECK OR MONEY ORDER PAYABLE TO: "REGISTER OF WILLS, AGENT." PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID C-) PAYMENT MUST BE MADE BY 08-30-ZOOq~. TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE TF pAID AFTER THTS DATE., SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ~ ( IF TOTAL DUE TS LESS THAN $1, NO PAYMENT IS REI~UTRED. TF TOTAL DUE IS REFLECTED AS A '"CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) .00 225.26 .00 225.26 NOTICE: To fulfill the requirements of Section Z140 of the Inheritance and Estate Tax Act, Act Z$ of ZOO0. (7Z P.S. Section 9140). PAYMENT: REFUND (CR): OBJECTIONS: ADMIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: Detach the top portion of this Notice and submit mith your payment to the Register of Rills printed on the reverse side. -- Make check or money order payable to: REGISTER OF N/LLS, AGENT. A refund of a tax credit, which was not requested on the tax return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available at the Office of the Register of Rills, any of the Z3 Revenue District Offices or by calling the special Z4-hour answering service for forms ordering: 1-aOO-36Z-Z050~ services for taxpayers with special hearing and or speaking needs: 1-800-447-30Z0 (TT only). Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions or assessment of tax (including discount or interest) as shown on this Notice amy object within sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. Z810Zl, Harrisburg, PA 17128-1021, OR --electing to have the matter determined at the audit of the account of the personal representative, OR --appeal to the Orphans' Court Factual errors discovered on this assessment should ba addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Raviaa Unit, DEPT. Z80601, Harrisburg, PA 171Z8-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. If any tax due is paid within three (3) calendar months after the dscadent's death, a five percent (SI) discount of the tax paid is allowed. The 15Z tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the data of death, to the date of payment. Taxes which became delinquent before January 1, 198Z bear interest at the rate of six (6Z) percent per annum calculated at a daily rate of .000164. Al! taxes which became delinquent on or after January 1, 198Z will bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 198Z through ZOO4 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 198Z 20X .000548 198'--8-1991 llZ .gO0301 ZOO"--~ 9Z .000247 1983 16Z .000438 1992 9Z .000247 ZOO2 6Z .000219 1984 11Z .000301 1995-1994 7Z .O00Xgz ZOO3 5Z .000137 1985 13Z .000356 1995-1998 9Z .000Z47 ZOO4 4Z .000110 1986 lOZ .D00274 1999 7Z .000192 1987 9Z .000Z47 2000 aZ .000Z19 --Interest is calculated as folloes: INTEREST = BALANCE OF TAX UNPAID X NUHBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (1S) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated. '~.BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX D[VTSION DEPT. 280601 HARRTSBURG, PA 17128-0601 Recorz ~ ~ CONHONHEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEHENT. ALLONANCE OR DISALLOHANCE OF DEDUCTIONS, AND ASSESSHENT OF TAX ON JOINTLY HELD OR TRUST ASSETS '04 ~R 12 P1:45 VIRGINIA M COVALESKI Zq NATURES XING ENOLA ~,i~ ~PA 17025 ~ DATE 05-15-200q ESTATE OF MATTERN HETTIE DATE OF DEATH 11-29-Z005 FILE NUHBER 21 0~-0155 COUNTY CUHBERLAND SSN/DC 232-03-3070 ACN 0~10~659 Amoun~ Remi~ed HAKE CHECK PAYABLE AND REHIT PAYHENT TO: REGISTER OF HILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~-- RETAIN LOHER PORTION FOR YOUR RECORDS ~ REV-1548 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEHENT, ALLOHANCE OR DISALLOHANCE OF DEDUCTIONS, AND ASSESSHENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 03-15-200q ESTATE OF HATTERN HETTIE F DATE OF DEATH 11-29-2003 COUNTY CUHBERLAND FILE NO. 21 0q-0135 S.S/D.C. NO. 232-03-5070 ACN OqlOq6$9 TAX RETURN HAS: (X) ACCEPTED AS FILED ( ) CHANGED JOINT OR TRUST ASSET ZNFORNATZON FINANCIAL INSTITUTION: PNC BANK ACCOUNT NO. 31200215205 TYPE OF ACCOUNT: ( ) SAVINGS ( ) CHECKING ( ) TRUST (~ TIHE CERTIFICATE DATE ESTABLISHED 07-1q-Z001 Account Balance 10,OZ1.0q Percent Taxable X 0.500 Amount Subject to Tax 5,010.52 Debts and Deductions - .00 Taxable Amount 5,010.52 Tax Rate X .~5 Tax Due ZZ5.q7 TAX CRED'rTS: NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS NOTICE HITH YOUR TAX PAYMENT TO THE REGISTER OF HILLS AT THE ABOVE ADDRESS. MAKE CHECK OR HONEY ORDER PAYABLE TO: "REGISTER OF HILLS, AGENT." PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) PAYMENT MUST BE MADE BY 08-30-200q~. TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE ZF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REgUIRED. ZF TOTAL DUE IS REFLECTED AS A "CREDIT" ( CR}, YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. ) .00 ZZ5.q7 .00 225.q7 PURPOSE OF NOTICE: To Tulfill tho requirements of Section Zl~O of the Inheritance and Estate Tax Act, Act Z5 of ZOO0. (TZ P.S. Section 91~0). PAYHENT: REFUND (CR)= OBJECTIONS: ADHIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST= Detach the top portion of this Notice and submit with your payment to the Register of Hills printed an the reverse side. -- Hake check or money order payable to: REGISTER OF HILLS, AGENT. A refund of a tax credit, which ams nat requested on the tax return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1515). Applications are available at the Office of the Register of Wills, any of the 25 Revenue District Offices or by calling the special Z4-hour ansaering service for forms ordering: /-800-56Z-Z050; services for taxpayers aith special hearing and or speaking needs: 1-600-4~7-50Z0 (TT only). Any party in interest not satisfied with the appraisement, alleaance, or disallowance of deductions or assessment of tax (including discount or interest) as shown on this Notice may object within sixty (60) days of receipt of this Notice by: --aritten protest to the PA Department of Revenue, Board of Appeals, Dept. ZSIOZ1, Harrisburg, PA 171ZB-IOZ1, OR --electing to have the matter determined et the audit of the account of the personal representative, OR --appeal to the Orphans' Court Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Revise Unit, DEPT. Z60601, Harrisburg, PA 171Z8-0601 Phone (717) 787-6505. See page 5 af the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. If any tax due is paid within three (5) calendar months after the decedent's death, a five percent (5Z) discount of the tax paid is allowed. The 15Z tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 16, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same tiaa period as you mould appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning with first day of delinquency, or nine (9) months and one (Z) day free the date of death, to the date of payment. Taxes which became delinquent before January l, 198Z bear interest at the rate of six (6Z) percent per annum calculated at a daily rate of .00016q. All taxes which became delinquent on ar after January l, I98Z ail! bear interest at a rate which mil! vary calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 198Z through ZOOq are: Interest Daily Interest Daily interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 198'~'~ ZOZ .0005~6 198'~'-&-199! 11Z .000501 go0~ 9Z .O00Zq7 1983 16Z .000q58 199Z 9Z .000Z47 ZOOZ 6Z .000Z19 198~ 11Z .000501 1993-199~ 7Z .00019Z ZOO5 5Z .000157 1985 15Z .000556 1995-1998 9Z .O00Zfi7 ZO0~ ~Z .O0011O 1966 IOZ .000274 1999 72 .00019Z 1967 9Z .O00Zq7 ZOO0 BZ .000Z19 --/nterest is calculated as folloms: INTEREST = BALANCE OF TAX UNPATD X NUNBER OF DAYS DELINQUENT X DATLY 'rNTERBST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (IS) days beyond the date of the assessment. Xf payment is made after the interest computation date shown on the Notice, additionaZ interest must be calculated. BUREAU OF INDIVIDUAL TAXES TNHERZTANCE TAX DIVISION DEPT. ZB0601 HARRTSBURG) PA 17128-0601 COMMONNEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOt/ANCE OR DZSALLOt/ANCE OF DEDUCTIONS AND ASSESSMENT OF TAX REV-lS4? EX AFP CS1-03) VIRGINIA M COVALESK! Zq NATURES CROSSING ENOLA · ~ .~. DATE O$-Z9-ZOOq !~:~. · ESTATE OF MATTERN DATE OF DEATH 11-29-2005 F'rLE NUMBER 21 0~-0155 '04 ~iAR26 ~ICO)~TY CUMBERLAND ~-~ ~C~ 101 I Amoun~ PA 17025- lJ~Ti. HETTZE F MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLTSLE, PA 17015 CUT ALONG THIS LINE ~ RETAIN LONER PORT~ON FOR YOUR RECORDS ~ REV-15q7 EX AFP (01-03} NOTICE OF INHERITANCE TAX APPRAISEMENT~ ALLONANCE OR DISALLONANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF MATTERN HETTIE F FILE NO. 21 0q-0155 ACM 101 DATE 05-29-200q TAX RETURN t/AS: (X) ACCEPTED AS FILED ( ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAZSED VALUE OF RETURN BASED ON: ORZGZNAL RETURN 1. Reel Es~e~e (Schedule A) 2. S~ocks end Bonds (Schedule B) (2) 3. Closely Held Siock/Partnership Interest (Schedule C) ($) q. Mor~geges/No~as Receivable (Schedule D) (q) $. Cash/Bank Deposits/Misc. Personal Proper*y (Schedule E) ($) 6. Jointly Owned Proper~y (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. To,al Asse~s APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Cos~s/Misc. Expenses (Schedule H) (9) 10. Debts/Mortgage Liabilities/Liens (Schedule Z) (10) 11. To,al Deductions 12. Ne~ Value of Tax Re~urn 15. lq. Charitable/Governmental Bequests; Non-elec~ed 9115 Trusts (Schedule J) Ne~ Value of Es~e~e Sub~ec~ ~o Tax ZO/OOq.6$ 66~255.85 13~525.22 7,956. O0 21.50 .00 NOTE: To insure proper .00 credi~ ~o your account, .00 submi~ ~he upper portion .00 of ~his fore wi~h your ~ax payment. NOTE: 99,785.70 (15) .00 x O0 = .00 (16) 91,826.20 x Oq5 = q,132.18 (17) .00 x 12 = .00 (].a) .00 x 15 = .00 (19)-- fi,l$Z. 18 AMOUNT PAID 3,9Z5.57 TOTAL TAX CREDIT BALANCE OF TAX DUEI INTEREST AND PEN. TOTAL DUE ASSESSMENT OF TAX: 15. Amoun~ of Line lq a~ Spousal ra~e 16. Aeoun~ of Line lq *axable e~ Lineal/Class A ra~e 17. Amoun~ of Line lfi a~ Sibling ra~e 18. Amoun~ of Line 1~ taxable a~ CoZlateral/Class B rate 19. Princi ~al Tax Due TAX CREDITS: PAYMENT RECEIPT DISCOUNT (+) DATE NUMBER INTEREST/PEN PArD (-) 02-11-200q CDOO$5q9 206.61 11nes 1~, 15 and/or 16, 17, 18 and 19 w111 IF PAID AFTER DATE /NDZCATED, SEE REVERSE FOR CALCULATION OF ADDZTZONAL INTEREST. q,152.18 .00 .00 .00 { TF TOTAL DUE TS LESS THAN $1~ NO PAYMENT TS REI~UZRED. ZF TOTAL DUE ZS REFLECTED AS A "CRED/T" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) Z~ an assessment was issued prev/ously, reflect flgures that lnclude the total of ALL returns assessed to date. (11) 7. ")57. ~0 (12) 91,826.20 (15) . O0 (1~) 91,826. ZO RESERVATION: Estates of decadents dying on or before December 12, 19BI -- if any futura interest in the estate is transferred in possession ar enjoyment to Class B (collateral) beneficiaries of tho decedent after the expiration of any estate for life or for yearsj the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class B (collateral) rate on any such future interest. PURPOSE OF NOTICE: PAYMENT: REFUND (CR): OBJECTIONS: ADMIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of 2000. (72 P.S. Section 9140). Detach the top portion of this Notice and submit aith your payment to the Register of Nills printed on the reverse side. --Make check or money order payable to: REGISTER OF NILLS, AGENT A refund of a tax credit, ahich was not requested on the Tax Return, may ba requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available at the Office of the Register of Hills, any of the 23 Revenue District Offices, or by calling the special Z4-hour answering service for forms ordering: 1-BOg-36Z-ZgSO~ services for taxpayers #ith special hearing and / or speaking needs: 1-&06-447-3020 (TT only). Any party in interest not satisfied with the appraisement, allowancej or disallowance of daductions~ ar assessment of tax (including discount or interest) as shown on this Notice must object within sixty (60) days of receipt of this Notice by: --written protest to the PA Deportment of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 1712&-1021, OR --election to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. Factual errors discovered on this assessment should ba addressed in ariting to: PA Department of Revenue, Bureau of [ndividual Taxes, ATTN: Post Assessment Review Unit, Bept. 280601, Harrisburg, PA 17128-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions far Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanatlon of administratively correctable errors. If any tax due is paid within three (3) calendar months after the dacedant's death, a five percent (52) discount of the tax paid is allowed. The 15Z tax amnesty non-participation penalty is computed an the total of the tax and interest assessed, and nat paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning with first day of delinquency~ or nine (9) months and Dna (1) day from the date of death, to the date of payment. Taxes ~hich became delinquent before January 1, 1982 bear interest at the rate of six (6X) percent par annum calculated at a daily rate of .000164. 211 taxes which became delinquent on and after January l, 1982 will bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through ZOO4 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rata Factor 1982 ZOZ .000548 ~)'~'~-1991 XXZ .000501 ~ 92 .000247 1983 16X .000458 1992 9X .000247 2002 62 .000164 1964 llZ .000501 1993-1994 72 .000192 Z003 52 .000137 1985 132 .000356 1995-1998 92 .000Z47 Z004 4Z .000110 1986 lOZ .000274 1999 72 .000192 1987 lOX .000274 ZOO0 72 .000192 --Interest is calculated as fallows: INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELTNQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessoant. If payment is made after the interest computation date sheen on the Notice~ additional interest must be calculated. ~]~4,..,~;)~)"~j~,~'~'['~ DEPT. 280601 INHERITANCE TAX RETURN "~ HARRISBURG, PA17128'0601 RESIDENT DECEDENT DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR/ (IF APPLICABLE) SURVIVING SPOUSE'S NAME (~ST, FIRST, AND MtDDL~ INITIAL) ~ 1. Original Return ~2. Supplemen~l Return - ~ 4. Limited Estate ~ 4a. Future Interest Compromise {aam d ~ea~ affe~ ~2-1 ~ 7. Decedent Maintained e Living T~st (A~ch copy ~ 6. De.dent Died ~estate (A~ ~py of Will) ~ 9. Lit{getion Proceeds Re~ived ~ 10. Spousal Pove~y Credit (date of desth be~een 12-31-91 and 1-1-95) OFFICIAL USE ONLY FILE NUMBER .;z / -d_~_ o COUNTY CODE YEAR NUMBER SOCIAL SECURITY NUMBER THiS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTE~i~ OF WILLS SOCIAL SECURITY NUMBE~ [~5. Federal Estate Tax Return Required 8, Total Number of Safe Deposit Boxes [~11. Election to tax under Sec. 9113(A) (^~ch sch o) 0 x TELEPHONE NUMBER COMPLETE MAILING ADDRESS 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (5} (Schedule E) 6. Jointly Owned Property (Schedule F) (6) [---t Separate Billing Requested 7. ~ntar-Vivos Transfers & Miscellaneous Non-Probata Property (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) t0. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) 12, Net Value of Estate (Line 8 minus Line 11) OFFICIAL USE ONLY 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (8) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15, Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) 16. Amount of Line 14 taxable at lineal rate 17, Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collataral rate 19. Tax Due x.0 x .15 (15) (16) (17) (18) (19) B~R~.AU OF 114DIVZDUAL TAXES ~IHE~ITA.~C~ fAX DZVISZOH VIRGINIA N COVALESKI NATURES CROSSIN$ ENOLA PA 17025-1047 COMHOHMEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOT/CE OF 1)IHER/TANCE TAX APPRAZSEHENT, ALL~MANCE OR DZSALLO#ANCE OF DEDUCT/GNS AND ASSESSMENT OF TAX DATE ESTATE OF DATE OF DEATH FZLE NUI~ER COUNTY ACN 03-29-Z006` NATTERN 11-29-200S 21 06`-0155 CUNBERLAND 101 Amount Rmt:l~ctecl HETTIE F MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THZS LZNE ~ RETATN LONER PORT/ON FOR YOUR RECORDS REV-I.q~T EX AFP (01-03) NOTZCE OF ZNNERZTANCE TAX APPRAZSENENT, ALLONANCE OR DZSALLONANOE OF DEDUCTZONS AND ASSESSMENT OF TAX ESTATE OF MATTERN HETTIE F FILE NO. 21 06,-0135 ACN 101 DATE 03-29-2006` TAX RETURN #AS: (X) ACCEPTED AS F/LED ( ) CHANGED RESERVATION CONCERNTNG FUTURE ZNTEREST- SEE APPRATSED VALUE OF RETURN BASED 014: ORIGTNAL RETURN 1. ~ Es~te (Schedule A) (1) .GO 2. Stocks u~d Bo~ds (Schodulo B) (2) . OO $, Closely bid Stock/hr~rd~shiP ~torest (SchoduAe C) (3) . O0 q. #ortgegos/Hotes blv~blo (Schedulo D) (4) , OO s. c~sh/a~nk O~posits/gis=. r~rson~l p;~,~rt~ (Sd~dulo E) (S) 20,006`.63 6. do~nt/y Ore, md Prap~r~y (S~mdub F) (6) 6&f2SS.BS 7. Tr~nsf~s (Schedule ~) (7) 1~,523.22 8. To~l Assets (8) 99,785.70 APPROVED DEDUCTIONS AND EXEMPTZO~S: 7,936.00 9. Funm~l Expe~os/Adm. Costs/H/sc. Expenses (Schodule H) (9) 10. Debts/HorN Llsb/11ttos/Llens (Schodulo /) (18) 21. SO 11. To~l D~fuctlofls (T1) 7.q67.50 lz. bt v~tum of Trax Ibturn (/2) 91,826.20 .00 DATE NUMBER 02-11-2006` CD00556`9 19. PrTnc/p~l Trax Du~ 206.61 3,925.57 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE TF PAZD AFTER DATE 7Ji)ZCATED, SEE REVERSE FOR CALCULATZOR OF ADD~TIOflAL ZNTEREST. 4,132.18 .00 .00 .00 ( IF TOTAL DUE ZS LESS THAN ti, NO PAYHENT TS REQUIRED. /F TOTAL DUE ~S REFLECTED AS A ~CREDI-I~ (CR~, YOU HAY DE DUE 13. Chl~ri~lblm/~ovornl~n~l BeeAmStS; No~-oloc~od 9113 T~sts (~ J) (13) 1~. bt V~d of Esh*o ~ to Tu (lq) 91,826.20 ~E: l~ m asm~ vas ~ pr~i~, 1~ 14, ~ and/ar 16, 17, 18 and 19 w111 ~1~ ~1~s t~ t~1~ the t~al ~ ALL r~urns assessed to d~e. A~ES~E~ OF TAX: O0 x O0 = ,00 ~. ~ of L~ lq a~ ~1 ~ (~) ' 16. ~t of L~ 1~ ~1~ mt U~l/Cl~s A ~te ~16) 91~826.20 x Oq5 ~ ~,132.18 17. ~ of L1~ 14 ~ S~bl~ ~ (17) .00 X ~2 ~ ,00 1~. ~t of Lb 14 ~1~ ~ ~11a~Clsss · ~ (16) .00 X 15 = .00 REV-~511 EX+ (12-99) . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE H FUNERAL EXPENSES & ADMINISIRATIVE COSTS FILE NUMBER ,2-/ c~-- Debts of decedent must be reported on Schedule L ITEM NUMBER DESCRIPTION AMOUNT FUNERAL EXPENSES: City State__Zip Year(s) Commission Paid: Attorney Fees Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Street Address City State__Zip Relationship of Claimant to Decedent Probate Fees Accountant*s Fees Tax Return Preparer's Fees TOTAL (Also enter on line 9, Recapitulation) $ ~ ..5"~...~ ~Z (If more space is needed, insert additional sheets of the same size) COMMONWEALTH OF PENNSYLVANIA iNHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES~& LIENS FILE NUMBER .~! ~4- - o/.~,.,'" Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION TOTAL (Also enter on line 10, Recapitulation) AMOUNT Io3-oo ?S-..z/ (If more space is needed, insert additional sheets of the same size) BUREAU OF TNDZVZDUAL TAXES INHERITANCE TAX DT¥1STON DEPT. zDnG01 HARRTSBURG, PA 1711&-0601 CONMONNEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLO#ANCE OR DZSALLOHANCE OF DEDUCTIONS AND ASSESSMENT OF TAX RE¥-15~? EX AFP ¢01-0S) VIRGINIA N COVALESKI 2q NATURES CROSSING ENOLA PA 17025-10q2 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 08-$0-200~ MATTERN HETTIE 11-29-2005 21 0R-0135 CU.I~t~:'~. LAND MAKE CHECK PAYABLE AND R~ZT PAYMENT TO: REGISTER OF "~LLS CUMBERLAND CO"COURT:~-~USE CARLISLE, PA~:!17013~5 · CUT ALONG THZS LZNE ~ RETAXN LONER PORTZON FOR YOUR RECORDS REV-lA4? EX AFP (01-03) NOTZCE OF ZNHERZTANCE TAX APPRAZSEMENT, ALLONANCE OR DZSALLONANCE OF DEDUCTZONS AND ASSESSMENT OF TAX ESTATE OF MATTERN HETTIE FFZLE NO. ~! 0~-0155 ACN 10! DATE 08-~0-200~ TAX RETURN NAS: (X) ACCEPTED AS F~LED ( ) CHANGED RESERVATZON CONCERNZNG FUTURE ZNTEREST- SEE REVERSE APPRATSED VALUE OF RETURN BASED ON: SUPPLEMENTAL RETURN 1. Real Es4:a4:a (Schedule A) (1) 2. S4:ocks and Bonds (Schedule B) (2) $. Closely Held S4:ock/Par4:nmrship Zn4:mrms4: (Schedule C) ($) q. Mor4:gages/No4:as Receivable (Schedule D) (~,) $. Cash/Bank Dmposi4:s/Nisc. Personal Proper4:y (Schedule E) (5) 6. Join4:ly O~nad Propar4:y (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. To4:aZ Assm4:s APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expansms/Adm. Cos4:s/Misc. Expenses (Schedule H) (9) 10. Dmb4:s/Mor4:gagm Liabili4:ims/Limns (Schedule T) (10) 11. To4:a1 Deduc4:ions 12. Ne4: Value of Tax Re4:urn NO. 01 O0 NOTE: To insure proper O0 cradi4:4:0 your accoun4:, O0 subm14: ~ha upper por4:ion 00 of 4:his form wi4:h your O0 O0 (8) 756.37 15. NOTE: .00 5~656.61 (11) 6.~92.99 (lz) 6,592.99- Chari4:ablm/Govmrnman4:al Bmques4:s; Non-®lac4:md 911:5 Trusts (Schedule J) (1:5) . O0 Ne4: Value of Es4:ata SubSac4:4:0 Tax (lq) 85,q~5~.21 Zf an assessment ~as issued previously, 11nas 14, 15 and/or 16, 17, 18 and 19 ~111 reflect ~:igures that include the total of ALL returns assessed to date. ASSESSMENT OF TAX: 15. Amoun4: of Line lfi ~6. Amoun4: of LAne 1~ 17. Amoun4: of LAne 1~ 18. Amoun4: of Line lfi 19. Princi}al Tax Due TAX CREDITS: PAYMENT RECEIPT DZSCOUNT DATE NUHBER INTEREST/PEN PA~D (-) 02-11-200q CDOO$5q9 192.25 (15) .00 x O0 = .00 (16) 85,q$$.21 x Oq5= $,8qq.50 (17) . O0 x 12 = . O0 (18) .00 X 15 = .00 (19)= ~,8q(4.50 ZF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. AMOUNT PAZD q,117.80 273.$0CR .00 273.$0CR 3,925.57 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE ( ZF TOTAL DUE ZS LESS THAN $1, NO PAYHENT ZS REQUIRED. ZF TOTAL DUE ZS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.) RESERVATION: PURPOSE OF NOTICE: PAYHENT: REFUND (CR): OBJECTIONS: ADNIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: Estates of decedents dying on or before December 1Z, 198Z -- if any futura interest in the estate is transferred in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for life or for years, the Commonaaalth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the laeful Class B (collateral) rate on any such future interest. To fulfill the requirements of Section Z140 of the Inheritance and Estate Tax Act, Act 25 of ZOO0. (7Z P.S. Section 9140). Detach the top portion of this Notice and submit with your payment to the Register of Nills printed on the reverse side. --Hake check or money order payable to: REGISTER OF #ILLS, AGENT A refund of a tax credit, ahich was not requested on tho Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-iBI$). Applications are available at the Office of the Register of Hills, any of the Z3 Revenue District Offices, or by calling the specie1 Z4-hour ansaering service for forms ordering: 1-800-56Z-ZO50; services for taxpayers with special hearing and / or speaking needs: 1-800-447-SOZ0 (TT only). Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, or assessment of tax (including discount or interest) as shown on this Notice must object mithin sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Beard of Appeals, Dept. 281021, Harrisburg, PA 17128-1021, OR --election to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. Factual errors discovered on this assessment should be addressed in ariting to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. Z80601, Harrisburg, PA 171Z8-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-lSD1) for an explanation of administratively correctable errors. If any tax due is paid within three (3) calendar months after the decadent's death, a five percent (BI) discount of the tax paid is alloaed. The iSZ tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning aith first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes ahich became delinquent before January 1, 1982 bear interest at the rate of six (6Z) percent par annum calculated at a daily rata of .000164. All taxes ahich became delinquent on and after January 1, 198Z mill bear interest at a rata which mill vary from calendar year to calendar year aith that rate announced by the PA Department of Revenue. The applicable interest rates for 198Z through 2004 are: Interest Daily Interest Daily Interest Year Rata Factor Year Rate Factor Year 1982 ZOZ .0005~8 ~7)T8-1991 llZ .ooosol Zoo[ 1983 16X .000438 199Z 9Z .000247 ZOOZ 1984 111 .000S01 1993-1994 7Z .00019Z ZOOS 1985 ISZ .000S56 1995-1998 9Z .O00Z~7 2004 1986 IOZ .000274 1999 7Z .O0019Z 1987 IOZ .000Z74 ZOO0 7Z ,00019Z --Interest is calculated as folloes: Daily Rata Factor 9Z .O00Z~7 6Z .000164 5Z .0001S7 4Z .000110 INTEREST = BALANCE OF TAX UNPAID X NUHBER OF DAYS DELINQUENT X DA[LY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent mill reflect an interest calculatlon to fifteen (IS) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice) additional interest must be calculated. BUREAU OF ZNDTVZDUAL TAXES INHERITANCE TAX DIVISION DEPT. ZB0601 HARRISBURG,, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT REV-1607 EX AFP cOZ-OS) VIRGINIA M COVALESKI'.~A 2q NATURES CROSSING ENOLA P~.:~7025-10q2 DATE 09-Z7-ZOOq ESTATE OF MATTERN DATE OF DEATH 11-29-2005 FILE NUMBER 21 0q-0155 COUNTY CUMBERLAND ACN 101 I Amoun~ Remi~ed HETTIE F HAKE CHECK PAYABLE AND RENZT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 NOTE: To insure proper credi~ ~o your accoun~c, submit: ~he upper por~:ion of ~his fore wi~h your ~ax payment. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV-1607 EX AFP (01-03) ~N~ 'rNHERZTANCE TAX STATEMENT OF ACCOUNT ESTATE OF MATTERN HETTIE F FILE ND. Z1 0q-0155 ACN 101 DATE 09-27-200q THIS STATEMENT ZS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACH ZN THE NAMED ESTATE. SHO#N BELO# ZSA SUMMARY OF THE PRINCIPAL TAX DUE, APpLTCATZON OF ALL PAYMENTS, THE CURRENT BALANCE, AND, ZF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 08-25-200q PRINCIPAL TAX DUE: ........................................................................................................................................................................................................................... PAVMENTS CTAX CREDITS): 5,8qq.50 PAYMENT RECEIPT DISCOUNT C+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 192.25 02-11-200q 09-07-200q CDOO55q9 REFUND .00 5,925.57 275.50- TOTAL TAX CREDIT 5,8qq.50 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 ZF PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( ZF TOTAL DUE ZS LESS THAN $1, NO PAYMENT ZS REgUZRED. ZF TOTAL DUE ZS REFLECTED AS A 'CREDIT' (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) PAYMENT: Detach the top portion of this Notice and submit with your payment mede payable to the name and address printed an the reverse side. -- ZF RESIDENT DECEDENT make check or money order payable to: REGISTER OF NZLLS, AGENT. -- If NON-RESIDENT DECEDENT make check or money order payable to: COMHONNEALTN OF PENNSYLVANIA. REFUND (CR): A refund of a tax credit, ahich was not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available at the Office of the Register of Nills, any of the 23 Revenue District Offices or from the Department's 2q-hour answering service for fores ordering: 1-800-362-2050; services For taxpayers ~ith special hearing and / or speaking needs: 1-800-qq7-3020 (TT only). REPLY TO: Questions regarding errors contained on this notice should be addressed to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 280601, Harrisburg, PA 17128-0601, phone (717) 787-6505. DISCOUNT: If any tax due is paid ~ithin three (3) calendar months after the decedent's death, a five percent (51) discount of the tax paid is ello~ad. PENALTY: The 151 tax amnesty non-participation penalty is computed on the tats1 of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. INTEREST: Interest is charged beginning ~ith first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January i, 1982 bear interest at the rate of six (6Z) percent per annum calculated at a daiZy rate of .00016q. A11 taxes ~hich became delinquent on and after January 1, 19BZ will bear interest at a rate which ~ill vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year 1982 ZOZ .O00Sq8 1988-1991 1XZ .000301 2001 1983 XBX .000438 1992 9Z .OOOZq7 2002 1984 112 .000301 1993-1994 72 .000191 2003 1985 131 .000356 1995-1998 91 ,000147 Z004 1986 101 .000274 1999 7Z .000191 1987 9Z .000247 2000 62 .000219 The applicable interest rates for 19BE through 2004 ara: Interest Daily Rate Factor 9Z .000247 6X .000164 5Z .000137 4Z .000110 --Interest is calculated as follows: TN?ERBST = BALANCE OF TAX UNPATD X NUNBER OF DAYS DELTNI~UEN? X DATL¥ TN?ERF. S? FACTOR --Any Notice issued after the tax becomes delinquent wil! reflect an interest calculation to fifteen (15) days beyond the date of the assessment. IF payment is made after the interest computation date sho~n on the Notice, additional interest must be calculeted.